2019 Athlete/Parent Concussion Awareness Form
DANGERS OF CONCUSSION
Concussions at all levels of sports have received a great deal of attention and a state law
has been passed to address this issue. Adolescent athletes are particularly vulnerable to
the effects of concussion. Once considered little more than a minor “ding” to the head, it
is now understood that a concussion has the potential to result in death, or changes in
brain function (either short-term or long-term). A concussion is a brain injury that results
in a temporary disruption of normal brain function. A concussion occurs when the brain
is violently rocked back and forth or twisted inside the skull as a result of a blow to the
head or body. Continued participation in any sport following a concussion can lead to
worsening concussion symptoms, as well as increased risk for further injury to the brain,
and even death.
Athlete and parental education in this area is crucial—that is the reason for this
document. Refer to it regularly. This form must be signed by a parent or guardian of each
swimmer who wishes to participate in GCSL activities. One copy needs to be returned to
your team’s Primary Council, and one retained at home.
COMMON SIGNS AND SYMPTOMS OF CONCUSSION
● Headache, dizziness, poor balance, moves clumsily, reduced energy
● Nausea or vomiting
● Blurred vision, sensitivity to light and sounds
● Fogginess of memory, difficulty concentrating, slowed thought processes, confused about surroundings or assignments
● Unexplained changes in behavior and personality
● Loss of consciousness (NOTE: This does not occur in all concussion episodes.)
The following is a link to Heads Up, the online concussion awareness and safety
recognition program offered by the Centers for Disease Control and Prevention. Please
visit the site and explore the program.
I HAVE READ THIS INFORMATION AND I UNDERSTAND THE FACTS PRESENTED HERE. I HAVE REVIEWED THIS INFORMATION WITH MY CHILD.
YES, I AGREE.
Enter your initials to indicate acceptance: